Everything You've Always Wanted to Know About Botox (But Were Afraid to Ask)

It's the most popular cosmetic treatment in the United States, but Botox continues to inspire fear and confusion in certain cautious corners. (And, OK, millions of dollars' worth of admiration.) Is it right for you? That depends on your taste, pocketbook, and tolerance for needles. We explain all.

Absolutely. Botox (and competitors like Dysport and Xeomin, which will be widely available next January) are highly purified toxins that can temporarily erase or reduce horizontal forehead lines, vertical frown lines, and crow's-feet. "The injections slow muscles that contract hundreds of times a day, eventually etching lines in the skin," says New York City plastic surgeon Michael Kane, author of The Botox Book (St. Martin's Press). Botox can also lift the corners of the mouth that sag with age, smooth out the "pin cushion" look in some chins, soften smoker's lines around the mouth, and soften vertical neck cords.

It will not affect the nerves that cause sensation, or make you feel numb. When it is used correctly, it can lift the brow to give an appealing and sincere look. "But if too much is injected in the danger zone—the horizontal lines in the forehead—you can look Spocked, as in Spock from Star Trek," says Jean Carruthers, a Vancouver eye surgeon who, with her husband, Alastair, coauthored the first paper on the cosmetic benefits of Botox in 1989. That's why it's important to be treated by an experienced doctor who can judge the size of your muscles and how much Botox you will need.

Every drug has side effects, and Botox is no exception. Luckily, they tend to be minor and short-lived, according to Kane. In one to five percent of cases, there can be mild droopiness of the eyelid or eyebrow, which usually goes away within two weeks, and some patients experience slight bruising.

Prices vary widely. The average is $400 per treatment, but experienced doctors tend to charge more. The toxins come dehydrated and must be reconstituted, so some doctors reportedly over-dilute, or simply don't use enough. "The quality of the result always depends on who is on the other end of the needle," says Kane.

You don't need it before you have wrinkles to hide. Other than that, a patient can have Botox safely whenever they are bothered by their wrinkles. There is no issue with long term use: "I've had patients who have used it repeatedly for over 20 years without bad effects," says Kane.

You can visit manufacturers' websites—botoxcosmetic.com,dysportusa.com, and xeomin.com—to find providers in your area. And ask friends—the ones who admit to using it. For the best treatment, seek out doctors in academic settings or those who have written about it. "This is where you have to use all your antennae," says Carruthers.

Yes and no. A good result will leave you looking fresher, more cheerful, and perhaps younger. Telltale signs of Botox that has been badly done are a smooth and shiny forehead, or a forehead and crow's-feet that don't move when you laugh or cry.

Not much. Results begin to show in a couple of days and develop gradually over the course of two weeks. "I tell anyone preparing for a big event to have shots two weeks ahead of time," says Kane. Some observers believe Dysport sets in faster than Botox, but that has not been proven in a study. Patients taking medications that contain aspirin or NSAIDs can develop pinpoint blue bruising. Patients can wear makeup immediately but should avoid heavy workouts for 24 hours, says Carruthers.